Epidemiology and Microbiology of Nosocomial Pediatric Candidemia at a Northern Indian Tertiary Care Hospital

The availability and aggressive use of chemotherapeutic and immunosuppressive agents as well as broad-spectrum antibacterial agents have created a large population of patients who are at increased risk of acquiring infections with fungal organisms, especially Candida species. Present work was undertaken to study the epidemiology and microbiology of candidemia and Candida colonization in hospitalized children. A total of 323 suspected cases of septicemia were enrolled, of which blood culture from 7.4% subjects was positive for Candida species. In total, 57.3% subjects were colonized by Candida species at least at one of the tested sites. Of 337 isolates, 24.3, 71.5, 2.9, 0.59, and 0.59% were Candida albicans, Candida tropicalis, Candida krusei, Candida kefyr, and Candida lusitaniae, respectively. Antifungal susceptibility results show that fluconazole, itraconazole, and amphotericin B resistance is prevalent in 18.2, 2.4, and 3.6% of C. albicans isolates, and 21.1, 4.6, and 0.04% of C. tropicalis isolates, respectively. In a large number of cases, source of blood infection was patient’s own colonizers, as shown by genetic matching. It was also noted that some strain types are circulating within the ward. High prevalence of non-albicans candidemia with high resistance to fluconazole is prevalent in North Indian hospitalized children.     

Nosocomial Candidemia in a tertiary care hospital in Saudi Arabia

Demographic information, risk factors, therapy, and outcome for all patients who had candidemia at King Fahad teaching hospital Al-khobar, between January 1995 and January 2000 were retrospectively reviewed. Thirty-two candidemic patients were identified. Candida parapsilosis was the most frequently isolated species (44%), followed by Candida tropicalis (25%), Candida albicans (19%), Candida krusei (6%), Candida glabrat a (3%), and Candida guilliermondi (3%). Risk factors included recent broad-spectrum antibiotics use (100%), ICU residency (71%), central venous catheters (66%), recent surgery (56%), total parenteral nutrition (43%), and immunosuppressive therapy (31%). Fluconazole was used before the onset of candidemia in only two patients. The overall mortality rate was 44%. Eight (25%) episodes of candidemia were not diagnosed and treated before the patient's demise. In view of the high mortality rate associated with hematogenous candidiasis, and lack of sensitive and specific laboratory tests necessary for the premortem diagnosis of infection, empirical antifungal therapy is recommended for high-risk patients. This revised version was published online in June 2006 with corrections to the Cover Date.     

Nosocomial Candidemia; Risk Factors and Prognosis Revisited; 11 Years Experience from a Norwegian Secondary Hospital

The aim of the study was to review the epidemiology and prognosis of candidemia in a secondary hospital, and to examine the intra-hospital distribution of candidemia patients. Study design is a retrospective cohort study. Trough 2002–2012, 110 cases of candidemia were diagnosed, giving an incidence of 2, 6/100000 citizens/year. Overall prognosis of candidemia was dismal, with a 30 days case fatality rate of 49% and one year case fatality rate of 64%. Candidemia was a terminal event in 55% of 30 days non-survivors, defined as Candida blood cultures reported positive on the day of death or thereafter (39%), or treatment refrained due to hopeless short-term prognosis (16%). In terminal event candidemias, advanced or incurable cancer was present in 29%. Non-survivors at 30 days were 9 years (median) older than survivors. In 30 days survivors, candidemia was not recognised before discharge in 13% of cases. No treatment were given and no deaths or complications were observed in this group. Candidemia patients were grouped into 8 patient categories: Abdominal surgery (35%), urology (13%), other surgery (11%), pneumonia (13%), haematological malignancy (7%), intravenous drug abuse (4%), other medical (15%), and new-borns (3%). Candidemia was diagnosed while admitted in the ICU in 46% of patients. Urology related cases were all diagnosed in the general ward. Multiple surgical procedures were done in 60% of abdominal surgery patients. Antibiotics were administered prior to candidemia in 87% of patients, with median duration 17 (1–108) days. Neutropenia was less common than expected in patients with candidemia (8/105) and closely associated to haematological malignancy (6/8). Compared with previous national figures the epidemiology of invasive candidiasis seems not to have changed over the last decade.     

Nosocomial Bloodstream Infections in Brazilian Pediatric Patients: Microbiology,Epidemiology, and Clinical Features

Background

Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients.

Methods

We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project).

Results

In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem.

Conclusions

In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.     

An Update on the Epidemiology of Candidemia in Children

Candidemia is a cause of significant morbidity and mortality in neonates and children. Risk factors for candidemia include prolonged stay in the intensive care unit, prior antibiotic therapy, immunosuppression related to malignancy, transplantation, use of immunosuppressants or steroids, neutropenia, need for mechanical ventilation, use of vasopressors, recent surgery (especially gastrointestinal), intravenous catheters and receipt of total parenteral nutrition. Candida albicans followed by C. parapsilosis are the most common species causing candidemia in children. Clinicians must be aware of the risk factors for candidemia and the local epidemiology of Candida species in order to direct antifungal therapy appropriately. Ongoing efforts to minimize health care-associated candidemia through infection control practices, judicious antimicrobial use and antifungal prophylaxis in appropriate situations are important to reducing Candida-associated morbidity and mortality in neonates and children.     

Epidemiology of Candidemia in Latin America: A Laboratory-Based Survey

Background

The epidemiology of candidemia varies depending on the geographic region. Little is known about the epidemiology of candidemia in Latin America.

Methods

We conducted a 24-month laboratory-based survey of candidemia in 20 centers of seven Latin American countries. Incidence rates were calculated and the epidemiology of candidemia was characterized.

Results

Among 672 episodes of candidemia, 297 (44.2%) occurred in children (23.7% younger than 1 year), 36.2% in adults between 19 and 60 years old and 19.6% in elderly patients. The overall incidence was 1.18 cases per 1,000 admissions, and varied across countries, with the highest incidence in Colombia and the lowest in Chile. Candida albicans (37.6%), C. parapsilosis (26.5%) and C. tropicalis (17.6%) were the leading agents, with great variability in species distribution in the different countries. Most isolates were highly susceptible to fluconazole, voriconazole, amphotericin B and anidulafungin. Fluconazole was the most frequent agent used as primary treatment (65.8%), and the overall 30-day survival was 59.3%.

Conclusions

This first large epidemiologic study of candidemia in Latin America showed a high incidence of candidemia, high percentage of children, typical species distribution, with C. albicans, C. parapsilosis and C. tropicalis accounting for the majority of episodes, and low resistance rates.     

Characterization of Cultivable Bacteria from Brazilian Sponges

Among 1,236 colony-forming units (CFU) associated with 11 species of marine sponges collected from a Brazilian coast, a total of 100 morphologically different bacterial strains were analyzed. The phylogenetic diversity of the bacterial isolates was assessed by 16S rRNA gene amplification—restriction fragment length polymorphism (RFLP) analysis, using AluI restriction endonuclease. The RFLP fingerprinting resulted in 21 different patterns with good resolution for the identification of the bacterial isolates at the genus level. The genus Bacillus was the most commonly encountered genus, followed by Kocuria. Regarding the relationship between the morphotypes and species of marine sponges, Mycale microsigmatosa presented major diversity, followed by Dragmacidon reticulatum and Polymastia janeirensis. An antibiotic susceptibility profile of the 100 sponge-associated bacterial strains was determined by the disk diffusion method, and we observed a variable resistance profile, with 15 % of the bacteria being multiresistant. In addition, 71 of 100 strains were able to produce biofilm. These 71 strains were divided into 20 strong biofilm producers, 10 moderate biofilm producers, and 41 weak biofilm producers. The plasmid profile of the 100 bacterial strains was analyzed and 38 (38 %) of these samples possessed one or more plasmids. Studies like this are important to increase the information on these associated bacteria found off the coastline of Brazil, a place which has rich biodiversity that is still unknown.     

Characterization of feather-degrading bacteria from Brazilian soils

Studies on keratinolytic microorganisms have been mainly related to their biotechnological applications and association with animal pathologies. However, these organisms have an ecological relevance to recycling keratinous residues in nature. This work aimed to select and identify new culturable feather-degrading bacteria isolated from soils of Brazilian Amazon forest and Atlantic forest. Bacteria that were isolated from temperate soils and bacteria from Amazonian basin soil were tested for their capability to grow on feather meal agar (FMA). Proteolytic bacteria were tested for feather degradation and were further identified according to their morphological and biochemical characteristics. Also, molecular identification based on 16S rDNA gene sequencing was carried out. A total of 24 proteolytic and 20 feather-degrading isolates were selected; Most of the isolates were from the Bacillus genus (division Firmicutes), but one Aeromonas, two Serratia (??-Proteobacteria), and one Chryseobacterium (Cytophaga-Flavobacterium group).     

Characterization of Piperacillin/Tazobactam-Resistant Klebsiella oxytoca Recovered from a Nosocomial Outbreak

We characterized 12 clinical isolates of Klebsiella oxytoca with the extended-spectrum β-lactamase (ESBL) phenotype (high minimum inhibitory concentration [MIC] values of ceftriaxone) recovered over 9 months at a university hospital in Japan. To determine the clonality of the isolates, we used pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST), and PCR analyses to detect bla _RBI, which encodes the β-lactamase RbiA, OXY-2-4 with overproduce-type promoter. Moreover, we performed the isoelectric focusing (IEF) of β-lactamases, and the determination of the MICs of β-lactams including piperacillin/tazobactam for 12 clinical isolates and E. coli HB101 with pKOB23, which contains bla _RBI, by the agar dilution method. Finally, we performed the initial screening and phenotypic confirmatory tests for ESBLs. Each of the 12 clinical isolates had an identical PFGE pulsotype and MLST sequence type (ST9). All 12 clinical isolates harbored identical bla _RBI. The IEF revealed that the clinical isolate produced only one β-lactamase. E. coli HB101 (pKOB23) and all 12 isolates demonstrated equally resistance to piperacillin/tazobactam (MICs, >128 μg/ml). The phenotypic confirmatory test after the initial screening test for ESBLs can discriminate β-lactamase RbiA-producing K. oxytoca from β-lactamase CTX-M-producing K. oxytoca. Twelve clinical isolates of K. oxytoca, which were recovered from an outbreak at one university hospital, had identical genotypes and produced β-lactamase RbiA that conferred resistance to piperacillin/tazobactam. In order to detect K. oxytoca isolates that produce RbiA to promote research concerning β-lactamase RbiA-producing K. oxytoca, the phenotypic confirmatory test after the initial screening test for ESBLs would be useful.     

Binge-Eating Disorder in Brazilian Women on a Weight-Loss Program

Objective: To examine binge-eating disorder (BED) and its association with obesity, weight patterns, and psychopathology in a Brazilian sample of female participants of a weight-loss program in São Paulo, Brazil. Research Methods and Procedures: Two hundred and seventeen overweight (body mass index ≥ 25 kg/m²) women, ages 15 to 59 years, enrolled in the Weight Watchers Program were recruited for the study at a program branch meeting after completing the Questionnaire on Eating and Weight Patterns–Revised, Beck Depression Inventory, and the Toronto Alexithymia Scale-20. Participants were categorized into four groups: those who met questionnaire criteria for BED, those who met questionnaire criteria for bulimia nervosa (BN), those that reported binge eating but did not meet all the criteria for any eating disorder (BE), and those with no eating disorder symptoms (No ED). Groups were compared on measures of weight, depressive symptoms, and alexithymia. Results: Binge eating was frequently reported by women in this study (BED, 16.1%; BN, 4.6%; BE, 22.6%). BED women had significantly higher body mass index, greater highest weight ever, and more frequent weight cycling than the No ED group. BED women also reported more depressive symptoms than BE and No ED women, and were more alexithymic than the No ED group. BE women presented more frequent weigh cycling and were also more depressed and alexithymic than the No ED group. Discussion: BED is not uncommon in overweight Brazilian women, and similar to North American and European samples, it is associated with overweight and higher levels of psychopathology in this population.     

Characterization of a new Acidobacteria-derived moderately thermostable lipase from a Brazilian Atlantic Forest soil metagenome

A clone (LP001) expressing a new lipase gene was isolated from a metagenomic library of the Brazilian Atlantic Forest soil. The DNA insert of LP001 was fully sequenced, and 38 ORFs were identified. Comparison of ORFs, %G + C content and gene organization with sequenced bacterial genomes suggested that the fosmid DNA insert belongs to an organism of the Acidobacteria phylum. Protein domain analysis and inactivation by transposon insertion showed that the protein encoded by ORF29 was responsible for the lipase activity and was named LipAAc. The purified LipAAc lipase was capable of hydrolyzing a broad range of substrates, showing the highest activity against p-nitrophenol (pNP) decanoate. The lipase was active over a pH range of 5.0-10.0 and was insensitive to divalent cations. LipAAc is moderately thermostable with optimum temperature between 50 and 60 °C and was thermally activated (80% activity increase) after 1 h incubation at 50 °C. Phylogenetic analysis suggested that the LipAAc is a member of family I of bacterial lipases and clusters with other moderately thermostable lipases of this group. Comparisons of the DNA insert of fosmid LP001 with other acidobacterial genomes and sequence database suggest that lipAAc gene has a fungal origin and was acquired by horizontal transfer.     

6719例住院患者医院感染的监测结果分析

目的:分析我院住院患者医院感染的发病特点和危险因素。方法:利用前瞻性监测和回顾性分析方法对2012年1~3月我院收治的6719例住院患者中发生医院感染的病例进行调查分析。结果:6719例住院患者发生医院感染145例,感染率2.16%;感染部位以呼吸系统为首(59.3%),其余依次为为胃肠道(17.2%)和泌尿道(11.7%);ICU的感染率最高,为22.0%,其次为外科系统(4.03%)和内科系统(1.71%)。病原学检测送检率为51.0%,阳性率为78.3%,共检出118株病原菌,其中革兰氏阴性菌占57.6%,真菌占22.9%,革兰氏阳性菌占17.8%。导致院内感染的危险因素中最常见的为放疗化疗(31.0%)、气管切开(15.9%)、导尿插管(17.9%)。结论:加强医务人员的感控意识,强化卫生制度,严格执行无菌操作规程,合理应用抗菌药物是控制医院感染发生的重要措施。     

6719例住院患者医院感染的监测结果分析

目的：分析我院住院患者医院感染的发病特点和危险因素。方法：利用前瞻性监测和回顾性分析方法对2012年1~3月我院收治的6719例住院患者中发生医院感染的病例进行调查分析。结果：6719例住院患者发生医院感染145例,感染率2.16%;感染部位以呼吸系统为首（59.3%）,其余依次为为胃肠道（17.2%）和泌尿道（11.7%）;ICU的感染率最高,为22.0%,其次为外科系统（4.03%）和内科系统（1.71%）。病原学检测送检率为51.0%,阳性率为78.3%,共检出118株病原菌,其中革兰氏阴性菌占57.6%,真菌占22.9%,革兰氏阳性菌占17.8%。导致院内感染的危险因素中最常见的为放疗化疗（31.0%）、气管切开（15.9%）、导尿插管（17.9%）。结论：加强医务人员的感控意识,强化卫生制度,严格执行无菌操作规程,合理应用抗菌药物是控制医院感染发生的重要措施。     

Epidemiology and Characterization of Seizures in a Pedigreed Baboon Colony

This study evaluated the incidence, prevalence, and clinical features of seizures in a pedigreed captive colony of baboons. The association of seizures with subspecies, age, sex, and various clinical features was assessed. Records for 1527 captive, pedigreed baboons were reviewed, and 3389 events were identified in 1098 baboons. Of these events, 1537 (45%) represented witnessed seizures, whereas the remaining 1852 presented with craniofacial trauma or episodic changes in behavior that were suggestive, but not diagnostic, of seizure activity. Seizures were generalized myoclonic or tonic–clonic, with two thirds of the events witnessed in the morning. Seizure onset occurred in adolescence (age, 5 y), with an average of 3 seizures in a lifetime. The incidence and prevalence of seizures were 2.5% and 26%, respectively, whereas the prevalence of recurrent seizures (that is, epilepsy) was 15%. Seizures were more prevalent in male baboons, which tended to present with earlier onset and more seizures over a lifetime than did female baboons. Seizures were equally distributed between the subspecies; age of onset and seizure recurrences did not differ significantly between subspecies. Clinical features including age of onset, characteristics, and diurnal presentation of seizures in baboons suggested similarities to juvenile myoclonic epilepsy in humans. Facial trauma may be useful marker for epilepsy in baboons, but its specificity should be characterized.The Texas Biomedical Research Institute (Texas Biomed; San Antonio, TX) is home to the Southwest National Primate Research Center, which manages the world''s largest baboon colony, currently comprising about 2500 baboons. Almost 2000 baboons, stretching across 5 to 7 generations and consisting of primarily olive baboons (Papio hamadryas anubis, 64%), yellow baboons (P. h. cynocephalus, 4%), and their hybrids (29%), belong to a pedigreed colony that is widely used for genetic research.²³ Baboons are ideal for the development of genetic models of human disorders due to the many genetic, anatomic, biochemical, and physiologic features shared by humans and baboons.^20,21 Researchers at numerous institutions have used baboons as animal models for a broad range of diseases including diabetes, heart disease, osteoporosis, and chronic infectious illnesses.^12,21Baboons are a natural model of idiopathic generalized epilepsy.⁸ The occurrence of seizures among colony baboons has been noted since the inception of our colony at Texas Biomed more than 50 y ago.⁹ The seizures occur spontaneously or are triggered by ketamine (used for sedation) or other stressors, such as handling or fighting among baboons. Often the seizures are not witnessed, but the baboons are found lying prone on the ground, presumptively having fallen from an elevated structure. These baboons often undergo craniofacial trauma, including periorbital lacerations or bruising, injury to the muzzle or mouth, and broken teeth. Nonetheless, most of these baboons are otherwise healthy, without evidence of developmental delay or focal neurologic deficits. Some baboons with seizures have been reported to be congenitally blind or demonstrate congenital brain damage,⁴ whereas others exhibit seizures as a result of head trauma or infectious diseases. For the most part, however, the baboons with seizures have normal brain anatomy.^8,11,16,19The seizures reported in our baboon colony are typically convulsive, either described as brief generalized myoclonic seizures or tonic–clonic seizures,^17,18 similar to those described in red baboons (P. h. papio)⁸ and humans.³ Previous scalp electroencephalographic studies characterizing epilepsy in the baboon colony demonstrated a high prevalence of generalized interictal epileptic discharges.¹⁷ As is true for P. h. papio, epileptic baboons in our colony are photosensitive (that is, seizures in the animals can be triggered by visual stimuli such as intermittent light stimulation).^9,11,17,18Electroclinical findings suggest that baboons provide an ideal animal model for idiopathic generalized epilepsies in humans. However, little is known about the natural history of epilepsy in baboons. In the current study, we present clinical data regarding the incidence, prevalence, and characteristics of the seizures; their age of onset and tendency to recur; and the effects of epidemiologic factors, including age, sex, and subspecies, on their expression.     

Microbiologic analysis of results from blood cultures

The aim of our investigations was the microbiological analysis together with the evaluation of sensitivity of bacteria frequently isolated from blood cultures. Blood samples were taken from patients with symptoms suggesting bacteremia in Rydygier's Hospital in Cracow. A total of 11,170 blood samples taken from 1997 to 2000 were tested. Automatic VITAL system (bioMerieux) was applied to culture and detect microorganisms. Bacteria were identified by ATB system (bioMerieux). Susceptibility was detected by ATB and disc diffusion method. Percentage of positive results relating to detection of microorganisms of clinical significance was 16.9% (1891 cultures). Staphylococcus spp. (Staph. epidermidis in range 22.8% to 21.9%), Enterococcus spp. and Streptococcus spp. were most frequently isolated species among aerobic Gram-positive bacteria. In 2000, compared to 1997 the number of isolates of MRSA increased considerably (from 1.8% to 6.8%). In blood infections the increase of frequency of E. coli bacteria was also noted: 6.1% and 11.4% in 1997 and 2000, respectively. Among non-fermentant bacilli the percentage of occurrence of P. aeruginosa in the period of 4 years was comparable in the range 7.3% in 1997 to 7.2% in 2000. The increase in the frequency of blood infections of A. baumanii was also noticed (respectively from 4.8% to 9.9%). Susceptibility of P. aeruginosa strains to selected beta-lactame antibiotics and aminoglycosydes increased in 2000 in comparison to 1999. A. baumanii strains were 100% sensitive only to imipenem.     

Towards a National AIDS-Control Program in Uganda

A national AIDS-control program was developed in Uganda to deal with a potentially serious epidemic of the acquired immunodeficiency syndrome (AIDS). A cumulative total of 1,138 cases of AIDS has been reported in Uganda between 1983—since AIDS was introduced into the country—and March 1987. More than 80% of the victims are sexually active persons whereas less than 10% are infants and children younger than 5 years. Virtually no cases or seropositivity is reported in persons between the ages of 5 and 14 years or after the age of 60 years. Most transmission has been through the heterosexual route, and, unlike in the United States, the male-female ratio is 1:1. Heterosexual high-risk behavior is cited as an important mode of transmission. A survey of household contacts showed that despite the closeness, only the sexual partners were seropositive.A five-year plan of action has been developed, and health education is the main thrust. It also includes blood screening, improved sterile procedures, improved surveillance and notification, research and terminal patient care. The plan stresses integration based on primary health care. There are unresolved moral issues of whether or not to tell the truth to an AIDS victim or any healthy seropositive person in developing countries, especially unstable persons. The best approach is to sensitize everyone so that they become guardians of their lives because sexual behavior is an issue of individual responsibility.     

Isolation and Characterization of a Type 2 Vaccine-Derived Poliovirus from Environmental Surveillance in China, 2012

Environmental surveillance of poliovirus on sewage has been conducted in Shandong Province, China since 2008. A type 2 vaccine-derived poliovirus (VDPV) with 7 mutations in VP1 coding region was isolated from the sewage collected in the city of Jinan in December 2012. The complete genome sequencing analysis of this isolate revealed 25 nucleotide substitutions, 7 of which resulted in amino acid alteration. No evidence of recombination with other poliovirus serotypes was observed. The virus did not lose temperature sensitive phenotype at 40°C. An estimation based on the evolution rate of the P1 coding region suggested that evolution time of this strain might be 160–176 days. VP1 sequence analysis revealed that this VDPV strain is of no close relationship with other local type 2 polioviruses (n = 66) from sewage collected between May 2012 and June 2013, suggesting the lack of its circulation in the local population. The person who excreted the virus was not known and no closely related virus was isolated in local population via acute flaccid paralysis surveillance. By far this is the first report of VDPV isolated from sewage in China, and these results underscore the value of environmental surveillance in the polio surveillance system even in countries with high rates of OPV coverage.     

Epidemiology of Pseudomonas aeruginosa in a Burns Hospital: Surveillance by a Combined Typing System

For 3 months, 259 cultures of Pseudomonas aeruginosa isolated from nonpatient environmental sources and 262 cultures from 16 infected patients in the Intensive Care Unit (ICU) of Shriners Burns Hospital were typed by a combined system with a high degree of reliability. Sinks were major sources of environmental contamination. Serotypes 1 and 2 were the predominant types found in patients, and they were most prevalent among typable strains from sinks. Strain designations were made on the basis of similarities in data from serological and phage typing. All nontypable strains were typed by pyocin production. Two infected patients carried different strains of P. aeruginosa that remained the same type for 45 days, even though their beds in ICU were approximately 6 feet apart. Cross-contamination from patient to patient and spread of infection by nursing personnel were eliminated as major modes of transmission because nasopharyngeal swabs, hair samples, and hands of nursing staff were consistently negative. Splashing of water from contaminated sinks to fomites was suggested as a possible mode of transfer for this infectious agent.     

Negative effects of tourism in a Brazilian Atlantic forest National Park

Specific impacts and benefits of nature tourism on species, ecosystem and socio-economic aspects have to be addressed in detail. This study compared diurnal medium-large vertebrate richness and abundance in a visited (VT) and a non-visited trail (NVT) in the mountain forest of Serra dos Órgãos National Park (SONP), a priority area for nature conservation in the Atlantic Forest hotspot. Results suggest that richness and abundance of medium-large mammals and birds are significantly reduced in VT, however sample effort was insufficient for further analysis. In the absence of adequate data, protected area managers have to guarantee infrastructure and control, but first, limit access by visitors, to small sized groups and low in frequency, guaranteeing large refuges for wildlife, and effective contributions for nature conservation with real socio-economic benefits at local and regional scales. The Brazilian government is investing in tourism in National Parks, including SONP, but there are no directives to monitor and manage potential negative impacts. Researchers and managers need to work together to couple this economic activity with environmental conservation in SONP and other protected areas in Brazil.